Key result
Combined late potentials and NSVT linked to ~14-fold higher post-MI fatal arrhythmic event risk.
Why the study?
Little is known about the usefulness of noninvasive ECG markers derived from ambulatory ECGs in patients with previous myocardial infarction.
Does the combined evaluation of ambulatory-based late potentials and nonsustained ventricular tachycardia predict fatal arrhythmic events in patients with previous myocardial infarction?
Cohort (n=104)
Single-blind
Yes
Does the combined evaluation of ambulatory-based late potentials and nonsustained ventricular tachycardia predict fatal arrhythmic events in patients with previous myocardial infarction?
Hazard Ratio: 14.1 (95% CI 3.4–58.9)
p-value: p=<0.0001
The combined evaluation of worst-value late potentials and nonsustained ventricular tachycardia on 24-hour ambulatory ECG is a powerful predictor of fatal arrhythmic events in patients with previous myocardial infarction.
May support combined ambulatory late potentials and NSVT for post-MI arrhythmic risk stratification; hypothesis-generating and requires prospective validation.
BACKGROUND: Noninvasive electrocardiographic (ECG) markers are promising arrhythmic risk stratification tools for identifying sudden cardiac death. However, little is known about the usefulness of noninvasive ECG markers derived from ambulatory ECGs (AECG) in patients with previous myocardial infarction (pMI). We aimed to determine whether the ECG markers derived from AECG can predict serious cardiac events in patients with pMI. METHODS: We prospectively analyzed 104 patients with pMI (88 males, age 66 ± 11 years), evaluating late potentials (LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT) derived from AECG. The primary endpoint was the documentation of ventricular fibrillation or sustained ventricular tachycardia. RESULTS: Eleven patients reached the primary endpoint during a follow-up period of 25 ± 9.5 months. Of the 104 patients enrolled in this study, LP positive in worst values (w-LPs) and NSVT were observed in 25 patients, respectively. In the arrhythmic event group, the worst LP values and/or NSVT were found in eight patients (7.6%). The positive predictive and negative predictive values of the combined assessment with w-LPs and NSVT were 56% and 94%, respectively, for predicting ventricular lethal arrhythmia. Kaplan-Meier analysis demonstrated that the combination of w-LPs and NSVT had a poorer event-free period than negative LPs (p < .0001). In the multivariate analysis, the combined assessment of w-LPs and NSVT was a significant predictor of arrhythmic events (hazard ratio = 14.1, 95% confidence intervals: 3.4-58.9, p < .0001). CONCLUSION: Combined evaluation of w-LPs and NSVT was a powerful risk stratification strategy for predicting arrhythmia that can lead to sudden cardiac death in patients with pMI.
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Hashimoto et al. (2020) conducted a cohort in Previous myocardial infarction (n=104). Combined evaluation of worst late potentials (w-LPs) and nonsustained ventricular tachycardia (NSVT) vs. Absence of combined w-LPs and NSVT was evaluated on Documentation of ventricular fibrillation or sustained ventricular tachycardia (HR 14.1, 95% CI 3.4-58.9, p=<0.0001). The combined assessment of worst late potentials and nonsustained ventricular tachycardia on ambulatory ECG significantly predicted fatal arrhythmic events in patients with previous myocardial infarction (HR 14.1).
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